Thursday, May 24, 2007

LA Times article on UC Mental Health

The past week in BMB has focused on psychiatry -- yesterday we learned about depression and today we learned about suicide. In fact, a speaker came to class today who described his struggle with bipolar disorder and how he tried to commit suicide by jumping off of the Golden Gate Bridge. He is only one of 29 people who have survived jumping off of the Golden Gate Bridge (out of an official estimate of 1500 who have jumped, and an unofficial estimate by the Marin Coroner's Office of 3500).

I feel like the LA Times article on mental health in the UC system ties neatly into the recent article on suicide among Asian American women. Considering the stats, it seems like there should be a service focusing on preventing suicide among Asian American women in particular! Since the Virginia Tech tragedy (there is something wrong to me about the world "massacre"), there has been a renewed interest in mental health, especially within universities. Learning about mental disorders in medical school right now is a strange coincidence.

From the LA Times

THE STATESuicides a symptom of larger UC crisisAs more students with mental health problems enroll, campuses lack theresources to cope.

By Richard C. Paddock, Times Staff Writer

May 23, 2007 DAVIS, CALIF. — As 20-year-old Jennifer Tse was dying in January, shetyped a message on her laptop to the coroner's investigators sheexpected would examine her body. The lonely UC Davis sophomore,depressed and struggling with her studies, had swallowed cold pills,antidepressants, dishwashing liquid and insect poison. "It's kind of rather sad, it's no way out," she wrote as she described her blurred vision, shaking muscles and a sense that her head was detached from her body. "Hopefully my IQ will stay at the same level. If I end up dead, then oh well." For five days, no one seemed to notice her absence until her roommate realized something was amiss, used a screwdriver to open the locked door to Tse's room and found her body on the floor. Tse's death is another grim statistic in what university administrators say is an escalating mental health crisis on campuses across the nation. She was one of at least nine students who committed suicide at UC Davisduring the last three academic years. Her death came four months after a high-level UC committee concluded that the university's overtaxed mentalhealth services fell "significantly short" and that the 10-campus system must urgently expand its counseling programs. "We have had an increasing number of students with serious mental health problems while services are lacking," said UC Santa Barbara Vice Chancellor Michael Young, co-chairman of the Student Mental Health Committee. "We just don't have the appropriate level of support to havehealthy campuses." The increase in mental health problems at UC is part of a national trend arising from the growing stress of university life and the growing number of students who arrive at college already under treatment formental illness, university psychologists and officials say. Advances in drug treatment mean that many students with psychological disorders who could not have coped with campus life a generation ago now go on to college.

The number of students seeking counseling at the eight main undergraduate campuses (not including UC San Francisco and the new UCMerced) rose 23% during 2000-01 to 2004-05 from 12,384 students to15,285 students. At UC, a quarter of the students who seek counseling are already on psychotropic medication. Many are being treated for depression and anxiety, some for bipolar disorder. Crises often occur when students, on their own for the first time, decide to experiment and go off their medications. It also is an age when undiagnosed psychological disorders can emerge. Across the country, about 1,300 college students a year commit suicide, experts say. Though university students are less likely than other age and occupational groups to take their own lives, suicide remains their second-leading cause of death. The UC Student Mental Health Committee called for "aggressive intervention" to reverse years of budget cuts in mental health services,double the counseling staff and implement dozens of recommendations to improve campus mental health care. UC needs 104 new psychologists just to meet national guidelines, administrators say. The UC Board of Regents received the report in September and in March agreed to designate part of an increase in student fees for mental health services. But that amount, about $4.6 million next year, will allow the campuses to hire only a fraction of the psychologists the panel recommended.

"Have we done enough? No, everyone agrees," Young said. For campus counselors who deal daily with depressed and disturbed students, the April 16 massacre and suicide at Virginia Tech by deranged student Seng-hui Cho was the realization of their worst nightmare. Buton a daily basis, campus counselors are stretched thin trying to helps tudents who are recovering from traumatic breakups, suffering from eating disorders or who intentionally cut themselves. At the same time, counselors must cope with students who disrupt classes, createdisturbances in residence halls or stalk women.

"There are more troubled kids, that's the bottom line," said Elizabeth Downing, who heads the UC Santa Barbara health center. "We boomer generation parents have not done a good job in a way. We were so laidback. Now there's so much stress. I think we've done our children a great disservice. They are driven in every part of their lives."

At UC Berkeley, 45% of students surveyed in 2004 said they had experienced an emotional problem in the previous 12 months that significantly affected their wellbeing or academic performance. Nearly 10% said they had seriously contemplated suicide. At UC Santa Barbara a decade ago, an average of 21 students a quarter came to the counseling center to report they were experiencing an emotional crisis. Now, more than 200 students a quarter come for help, saying they are in a crisis. "Our crises have gone way up and we have fewer psychologists to deal with that," said Jeanne Stanford, director of counseling services. "We feel like we have become a crisis center." UC has about one psychologist for every 2,300 students, far below theInternational Assn. of Counseling Services guideline of one psychologistfor every 1,000 to 1,500 students.

* Lengthy wait for helpFor UC students with nonemergency problems, the wait to see a counseloris three to six weeks — a long time when a quarter is only 11 weeks long. "There are many students who are on the edge," UC President Robert Dynessaid. "We are spending less and we have more kids with fewer services." The mental health committee reported that there were 29 confirmed suicides at UC campuses from 2000 to 2005. Panel members say that number is low because some suicides go unreported to the university and other suspected suicides are not confirmed. It's not just students who have killed themselves. UC's highest-profile suicide occurred in June when UC Santa Cruz Chancellor Denice Dee Denton jumped from the roof of her partner's 43-story apartment building in San Francisco. One of UC's worst tragedies occurred at Santa Barbara in 2001 when student David Attias drove his car into a crowd of pedestrians in thestudent community of Isla Vista, killing four people. He claimed he was the "angel of death." Attias had been on medication since the age of 11 for bipolar disorder and other conditions. After his arrest, he said he had stopped taking his drugs because he wanted to be like other students. In hopes of preventing similar incidents, UCSB now collects information on students who may be troubled and intervenes if they begin acting out.Like other schools, Santa Barbara has a crisis response team that includes police officers, counselors and administrators. Other campuses are also focusing on prevention. UC Berkeley, through a federal grant, has trained nearly 600 faculty, staff members andstudents to spot signs of depression and posted green stickers across the campus to show students where they can get help.

The UC system began examining campus mental health after the death of Adam Ojakian, a 21-year-old senior at UC Davis who shot himself in 2004. Suffering from depression and struggling academically, he received a letter from the university warning that his graduation could be jeopardized by his poor grades. Ojakian's parents, Victor and Mary Ojakian, believe his suicide — like most suicides — could have been prevented if his symptoms had been recognized and he had received treatment. Unlike many relatives of suicide victims, the Ojakians have spoken out publicly about their son'sproblems.

Victor Ojakian, a Palo Alto councilman at the time of his son's death, said one of the biggest obstacles in preventing suicides is overcomingthe stigma of mental illness. "We have a major health crisis and nobody wants to talk about it becauseof our cultural adversity to talking about problems involving the brain," he said.

Frustrated by UC's lack of action, the Ojakians got the regents' attention at one of their meetings in 2005, speaking during the brief public comment period. Their plea led to the appointment of the Student Mental Health Committee and its subsequent report. Victor Ojakian praised the panel's recommendations but said the amount of money allocated by the regents would fund only a "bare minimum" ofincreased services. "It won't address the second tier — reaching at-risk men and women —because that costs more," he said. "The Virginia Tech type of individual would go undetected with this kind of money."

At UC, officials have held to the idea that mental health treatment should be paid for with the student registration fee, which has been stagnant for decades. That fee, which pays for student services, rose gradually from $510 in1985-86 to $735 this year. By contrast, the education fee, the main fee students pay, rose over the same period from $723 to $5,046. As state funding for UC decreased, mental health services were cut in the early '90s and again this decade. In March, the regents agreed to raise both fees by 7%, with more than half the increase in the registration fee going to mental health services. But advocates say much more is needed. "We are already a decade and a half behind," Young said. "What you saw at the regents' meeting was a very small first step."

UC officials would not discuss Jennifer Tse's suicide and her parents did not return telephone calls from The Times. It was unclear whether she sought or received treatment from the UC Davis counseling center. But Emil Rodolfa, who heads the center, said that it's easy for adepressed student to go unnoticed on the campus of 30,000, the third-largest in the UC system. "Depression sucks the life out of you," he said. "It causes people to withdraw and hide out. In these huge classes, it's hard to tell if a student is there or not." The report on Tse's death filed by the Yolo County coroner's office described her as "a highly intelligent young woman who held herself tovery high standards in her personal life as well as her studies."

She had a long history of depression, was prescribed Prozac and Wellbutrin and attempted suicide in high school, the report says. After starting at Davis, she took some time off and attended community college before returning last summer. On Sunday, Jan. 14, three daysbefore her death, she wrote in her diary: "I'm sooo lonely, so lonely.What shall I do bah bah and I must finish this paper, I must type. What can I type. I must type … I have to wait until wed. to see if I can call a counselor … I feel rather discouraged right now…. "

It's unclear whether she ever called the counselor. But that Wednesdaynight she swallowed whatever toxic items she could find in her apartment. "Okay, I think the meds are working," she wrote. "I think I will lie down and see what happens."

In an effort to make your UCSF blog reading experience a more balanced and wholesome experience, I've taken the liberty of adding the links to the blogs of some of my esteemed UCSF colleagues who represent the different health disciplines of the school. Though I tend not to pick favorites.---------albertjames

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